Intravenous Leiomyoma with Intracardiac Extension: A Rare Late Presentation After Hysterectomy

Jagat Narayan Prasad,Lokesh Shekher Jaiswal,Narendra Pandit,Naveen Kumar Pandey

doi:10.3126/njh.v17i2.32680

Jagat Narayan Prasad, Lokesh Shekher Jaiswal + Show 2 more

Open Access

https://doi.org/10.3126/njh.v17i2.32680

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Abstract

Intravenous leiomyoma is a rare, benign smooth muscle tumor arising from intrauterine venules or the myometrium. It can rarely present as intracardiac mass long after hysterectomy. In this case report we describe a 40-year-old female with previous history of hysterectomy, presenting with an intracardiac mass which was successfully managed with single stage tumor resection under cardiopulmonary bypass. Subsequent histopathology showed features of leiomyoma. The diagnosis of intravenous leiomyoma with cardiac extension should be kept in a female patient presenting with intracardiac mass with previous history of myomectomy or hysterectomy.

Highlights

Primary cardiac tumors in general are rare and predominantly benign.1Primary cardiac leiomyoma is even rarer[2], most of the cardiac leiomyomas are secondary to tumor metastasis or in continuity extension from the uterine leiomyoma.[3,4] Intravenous leiomyoma is defined as a benign, smooth muscle tumor arising from the intrauterine venules and/or the myometrium with identifiable growth within the lumen of veins.[3]
Transthoracic echocardiogram showed a mobile mass extending from the inferior venacava (IVC) into the right atrium (RA) and right ventricle (RV) (Figure 1, C)
The tumor thrombus was approached via median sternotomy under cardiopulmonary bypass (CPB) and moderate hypothermia

Summary

Introduction

Primary cardiac tumors in general are rare and predominantly benign.1Primary cardiac leiomyoma is even rarer[2], most of the cardiac leiomyomas are secondary to tumor metastasis or in continuity extension from the uterine leiomyoma.[3,4] Intravenous leiomyoma is defined as a benign, smooth muscle tumor arising from the intrauterine venules and/or the myometrium with identifiable growth within the lumen of veins.[3]. Abdominal ultrasonography, revealed a tumor thrombus in the retrohepatic inferior venacava (IVC) (Figure 1, A). Contrast enhanced computed tomogram of abdomen confirmed the tumor thrombus in the IVC (Figure 1, B) Transthoracic echocardiogram showed a mobile mass extending from the IVC into the right atrium (RA) and right ventricle (RV) (Figure 1, C).

Results

Conclusion